Healthcare Provider Details

I. General information

NPI: 1629175948
Provider Name (Legal Business Name): SEYDEL & SANCHEZ GENERAL SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 MEDICAL CENTER CT # 203
CHULA VISTA CA
91911
US

IV. Provider business mailing address

754 MEDICAL CENTER CT STE 203
CHULA VISTA CA
91911-6656
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-6493
  • Fax: 619-656-5727
Mailing address:
  • Phone: 619-656-6493
  • Fax: 619-656-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD RUBEN SANCHEZ
Title or Position: VICE-PRESIDENT
Credential: MD
Phone: 619-656-6493